Medical psychology

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Medical psychology (also known as Clinical Health Psychology, Psychosomatic Medicine, Health Care Psychology, Behavioral Medicine, or Health Psychology) revolves around the idea that both the body and mind are one, indivisible structure. Continuing with this line of thought, all diseases whether of the mind or of the physical body must be treated as if they have both been effected. So Medical psychology is the application of psychological principles to the practice of medicine for both physical and mental disorders.

The American Psychological Association (APA) defines medical psychology as "that branch of psychology that integrates somatic and psychotherapeutic modalities into the management of mental illness and emotional, cognitive, behavioral and substance use disorders". A medical psychologist does automatically equate with a psychologist who has the authority to prescribe medication.

Medical psychologists apply psychological theories, scientific psychological findings, and techniques of psychotherapy, behavior modification, cognitive, interpersonal, family, and life-style therapy to improve the psychological and physical health of the patient. Clinical psychologists with post doctoral specialty training as medical psychologists are the practitioners with refined skills in clinical observation in of the field of psychology, learning, central nervous system adaptation and change, and adaptation and lifestyle change applying a number of different methods in several different mediums of treatment. Highly qualified and post graduate specialized doctors are trained for service in primary care centers, hospitals, residential care centers, and long-term care facilities and in multidisciplinary collaboration and team treatment. They are trained and equipped to modify physical disease states and the actual cytoarchitecture and functioning of the central nervous and related systems using psychological and pharmacological techniques (when allowed by statute), and to provide prevention for the progression of disease having to do with poor personal and life-style choices and conceptualization, behavioral patterns, and chronic exposure to the effects of negative thinking, choosing, attitudes, and negative contexts.

Background

The belief that the corporeal and the physical bodies are one is by no means new. Socrates introduced the Greeks to this idea in several of his works, however for a time in the Early Modern period, it was lost to René Descartes' (also known as Cartesian) belief of the two separate bodies. Only recently has this arcane thoguht been reintroduced into medical schools across the world.

The intent of Medical Psychology is to apply knowledge from all branches of psychology and medicine in the prevention, assessment, and treatment of all forms of physical diseases. Medical psychology asserts its main function in the determination of personality styles of coping and the examination of attitudes of an individual in response to subjective and objective stressors. Medical psychologists also help in the determination of genetic, biochemical, and physiologic factors in illnesses and reaction to illness. These, then, are joined with psychosocial factors deemed contributory to diseases processes. Specific behavioral methods are then used to help the person match coping and management skills to the person’s abilities, character, and personality style.

Some doctors and philosophers today believe that this Cartesian line of thought is outdated. Some anecdotal evidence has been raised concerning the lack of effective treatment for things such as migraines, pains and cancer and that perhaps the cure should not only be centred on the body but also the mind. Some also raise the argument that most uncurable diseases are brought about not merely by physical ailments, but by mental problems. All evidence is of course unproven and will likely remain as such for a long time to come.

The contribution of medical psychologists to general health care increased with their use as primary care doctors in the world's largest HMO, the California Kaiser Permanente. These psychologists work along with primary care physicians in order to determine optimum treatment plans for all patients with physical and/or mental illnesses.

Behavioral Medicine

Behavioral Medicine (related to Behavioral Health, Clinical Health Psychology and Psychosomatic Medicine) is a related branch of clinical practice in which psychologists emphasize the biopsychosocial approach to medicine, a model which recognizes the importance of addressing the interaction between physical, psychological and social factors in both the prevention and management of disease. Practitioners of behavioral medicine differ from medical psychologists in that they focus on the scientific application of behavioral interventions to a wide variety of medical conditions (e.g., asthma, gastrointestinal illnesses, cardiac conditions, spinal cord and brain injuries, chronic pain, headaches, and addictive illness).

An important contribution of medical psychology is in the education of patients (psychoeducation) in disease processes. Frequently, such education of the patient and the family insures substantially better compliance with treatment recommendations by physicians. Medical psychologists are particularly successful in the treatment of asthma, gastrointestinal illnesses, cardiac conditions, spinal cord and brain injuries, chronic pain, headaches, and addictions (drugs, smoking, eating, alcohol, etc.).

Training

Training in medical psychology entails a doctoral degree (Ph.D., or Psy.D.) in clinical psychology, an internship, and postdoctoral training in one of the branches of medicine traditionally associated with psychological fields: psychosomatic medicine, rehabilitation, neuropsychology (central nervous system functioning - brain functions), substance abuse, pain medicine, among others.

Certification in the US

The Academy of Medical Psychology defines medical psychology as a specialty trained at the post doctoral level and designed to deliver advanced diagnostic and clinical interventions in Medical and Healthcare Facilities utilizing the knowledge and skills of clinical psychology, health psychology, behavioral medicine, psychopharmacology and basic medical science.

A specialty of medical psychology has established a specialty board certification, American Board of Medical Psychology and an Academy of Medical Psychology requiring a doctorate degree in psychology and extensive post doctoral training in the specialty and the passage of an oral or written examination.

Although the Academy of Medical Psychology defines medical psychology as a "specialty" and has established a "specialty board certification," it is important to note that the American Psychological Association does not currently recognize medical psychology as a "specialty." However, Louisiana does recognize this area of expertise by statute (the Medical Psychology Practice Act) as a "profession of the health sciences" with prescriptive authority. It is equally important to note than the American Psychological Association does not recognize that the term medical psychology has, as a prerequisite, nor should the term be equated with having, prescriptive authority. In fact, no other organization in the world, outside of Louisiana statute and the Louisiana Academy of Medical Psychology, equates medical psychology with prescriptive authority, as a prerequisite.

In 2006, the American Psychological Association (APA) recommended that the education and training of medical psychologists, who are specifically pursuing one of several prerequisites for prescribing medication, integrate instruction in the biological sciences, clinical medicine and pharmacology into a formalized program of postdoctoral education.

The following Clinical Competencies are identified as essential in the education and training of medical psychologists:

I. Basic Science: anatomy, & physiology, biochemistry;

II. Neurosciences: neuroanatomy, neurophysiology, neurochemistry;

III. Physical Assessment and Laboratory Exams: physical assessment, laboratory and radiological assessment, medical terminology;

IV. Clinical Medicine and Pathophysiology: pathophysiology with emphasis on the principal physiological systems, clinical medicine, differential diagnosis, clinical correlation and case studies, chemical dependency, chronic pain management;

V. Clinical and Research Pharmacology and Psychopharmacology: pharmacology, clinical pharmacology, pharmacogenetics, psychopharmacology, developmental psychopharmacology;

VI. Clinical Pharmacotherapeutics: professional, ethical and legal issues, combined therapies and their interactions, computer-based aids to practice, pharmacoepidemiology;

VII. Research: methodology and design of psychopharmacology research, interpretation and evaluation, FDA drug development and other regulatory processes.

The 2006 APA recommendations also include supervised clinical experience intended to integrate the above seven knowledge domains and assess competencies in skills and applied knowledge.

The above prerequisites are not required or specifically recommended by APA for the training and education of medical psychologists not pursuing prerequisites for prescribing medication.

The national psychology practitioner association (NAPPP; www.nappp.org)and top national certifying body (Academy of Medical Psychology; www.amphome.org)have established the national training, examination, and specialty practice criterion and guidelines in the specialty of Medical Psychology and have established a national journal in the specialty. Such certifying bodies, view psychopharmacology training (either to prescribe or consult) as one component of the training of a specialist in Medical Psychology, but recognize that training and specialized skills in other aspects of the treatment of behavioral aspects of medical illness, and mental illness affecting physical illness is essential to practice at the specialty level in Medical Psychology. The Louisiana Academy of Medical Psychology (LAMP), currently the largest organization of psychologists with prescriptive authority in the world and the only organization representing practitioners of medical psychology in Louisiana as defined by Louisiana statute within any jurisdiction in the United States, no longer recognizes the Academy of Medical Psychology as an adequate certifying body for its practitioners, and its members have resigned from the Academy of Medical Psychology en masse. Similarly, virtually all members of LAMP have also resigned from the Louisiana Psychological Association (LPA) after many LPA members asserted that the LAMP's prescriptive authority movement secretly came to an agreement with Louisiana's medical board to transfer the practice of psychology for psychologists with prescriptive authority to the medical board.

See also

• Health psychology
• Medical sciences
• Prescriptive authority for psychologists movement

External links

• Medical Psychology Graduate Program at The University of Alabama at Birmingham